MEDICARE: SAMANTHA JO LENNOX CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	9918	MN

General Provider Information

NPI Number	:	1588123558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA JO LENNOX CCC-SLP

Provider Business Mailing Address
First Line	:	56954 240TH ST
Second Line	:
City	:	ALBERTA
State	:	MN
Zip	:	56207-4651
Country	:	US
Telephone Number	:	320-413-0203
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 COURT DR
Second Line	:
City	:	MORRIS
State	:	MN
Zip	:	56267-4722
Country	:	US
Telephone Number	:	320-585-5395
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	07/13/2023

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Directions to “ SAMANTHA JO LENNOX CCC-SLP” Practice Location

Language	Start Address	Practice Location

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